May 03, 2010

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Counting the ways Democratic candidates try to turn health care reform to their advantage will be a great 2010 sport. The latest comes from Democratic Rep. Ann Kirkpatrick in Arizona who has figured out that that along with the risk, there is at least some opportunity, specifically the opportunity to offer advice on the new law as yet another valuable constituent service. There’s surely something to be gained from helping seniors, for example, to get rid of that hole in their Medicare doughnut.

Congress Daily's Erin McPike reports: “As Republicans try to make Democrats pay a political price for supporting the recently enacted healthcare law, freshman Democratic Rep. Ann Kirkpatrick of Arizona is trying to turn questions about it to her advantage. Kirkpatrick sees helping residents of the sprawling 1st District understand the law and negotiate the changing healthcare system as ‘the next extension on the menu of constituent service options,’ Chief of Staff Michael Frias said. So in addition to asking for help with passports, visas, Social Security and other matters that congressional staffers deal with in district offices, members of Kirkpatrick's staff are now answering health questions. Other Democrats have heeded the advice of Democratic leaders and messaging gurus to ‘sell’ the bill to voters. For example, Reps. Tom Perriello, D-Va., and Betsy Markey, D-Colo., have sent mass mailings touting how the law closes the Medicare ‘doughnut hole.’”(subscription required)

It's Monday. "You’ve got to get up every morning with a Pulse on your face."

WHAT WE'RE WATCHING:

HHS HIGH-RISK POOL DEADLINE PASSES — Forty-three states met the HHS deadline to decide whether they would run the federally-funded, high-risk insurance pools required by the new law: 28 said yes, 15 said no and more than a handful remain to-be-determined. Kaiser Health News has a summary.

POLITICO's Jennifer Haberkorn: “The first major decision for the states under the new health care law—on establishing high risk insurance pools--has come and gone with the decisions so far made mostly along party lines. By the Friday deadline, most Democratic governors largely decided to help the Department of Health and Human Services by creating the pools themselves with federal funding. Most Republican governors decided to allow the federal government to establish its own high-risk insurance pool in their states, essentially punting. The pools, which are temporary until 2014, could be a telling sign of how well the states and federal government work together on putting the rest of the overhaul into action.”

Some governors, such as Christie in New Jersey and Bredesen in Tennessee, did break party ranks on risk pools but there’s no sign this represents any sort of rebellion or writing off of their party’s stance on health care reform.

NEW JERSEY: GOV. CHRISTIE JOINS BUT HEDGES — The Record’s Matt Friedman reports: “Taking a different approach than most Republican governors, Gov. Chris Christie plans to claim federal funds so the state can run a high-risk insurance pool for people with pre-existing medical conditions as part of the national health care reform. … State Department of Banking and Insurance spokesman Marshall McKnight said the letter is ‘non-binding’ and ‘doesn’t necessarily mean we’re absolutely going to.’"

TENNESSEE: BREDESEN DECLINES BUT OFFERS ALTERNATIVE — The Tennessean’s Getahn Ward reports: “Tennessee won't be operating a new high-risk pool for uninsurable residents. … The state instead has recommended that federal authorities work with a nonprofit entity here to carry out and run a new pool that would offer health coverage to people who have been uninsured during the previous six months because of pre-existing medical conditions.”

WHAT WE'RE WONDERING – HOW MANY MORE STATE OPT-OUTS ON THE HORIZON? The Los Angeles Times’ Noam N. Levey reports: “As many as 20 states probably will not operate new insurance programs for Americans who have been denied health coverage, forcing the federal government to step in to implement one of the key elements of the healthcare overhaul legislation, according to administration officials.”

PULSE POLITICS:

MEDICAL INTERESTS SPENT $876 MILLION ON REFORM — Roll Call’s Bennett Roth and Alex Knott report: “Medical interests alone shelled out more than $876 million in lobbying expenses during the 15 months beginning in January 2009 and ending in March, when Congress passed the sweeping overhaul. Those stakeholders, including the drug industry, doctors, hospitals and manufacturers of medical products, were responsible for one out of every five dollars doled out on lobbying during that period, according to a CQ MoneyLine analysis of lobbying disclosure reports filed with Congress. … ‘That is an astounding amount of money,’ said Ralph Neas, president of the National Coalition on Health Care, which pushed for passage of the overhaul. Neas, who began his career in Washington in the 1970s as an aide to then-Sen. Edward Brooke (R-Mass.), said that in his time here, ‘I can’t think of anything that remotely comes close to that amount of lobbying.’”

FALLOUT:

LAWMAKERS OVERLOOK HEALTH INSURANCE FOR COLLEGE STUDENTS — The Wall Street Journal’s Mary Pilon reports: “lawmakers overlooked a big and growing problem at the center of the two issues: health care for college students. Not only do colleges sometimes overcharge students for health services, but school health plans are so confusing that students often don't know they owe money until they are hit with late fees. The result: spiraling medical bills for young people. … The college health system is a crazy quilt of private coverage and student plans, with few rules governing how schools charge for coverage or on-campus services. More than half of U.S. colleges offer a school-sponsored plan in which students pay premiums for coverage. Some automatically enroll students in their plans unless the students sign a waiver proving that they are covered by an outside policy. Other schools require students to use their plans no matter what. Still others require students to have outside coverage.”

SAN ANTONIO PREDICTS HEALTH CARE REAL ESTATE BOOM — The San Antonio Business Journal’s Tricia Lynn Sylvia reports: “The Healthcare Real Estate Group of Marcus & Millichap, in its 2010 outlook report on the medical office market, recently noted that health care reform could prove a boon for the medical real estate business. A common formula employed in the real estate industry is that for every health care patient, about 1.9 square feet of medical space is required, according to Kim Gatley, senior vice president and director of research for locally based NAI REOC San Antonio. By that formula, with San Antonio and Bexar County looking to add between 300,000 and 350,000 to its list of insured individuals, it stands to reason that more than 650,000 square feet of new medical space will be needed to accommodate these patients, notes Gatley.”

IMPLEMENTATION:

TOP CMS STAFFER MOVES TO WHITE HOUSE OFFICE OF REFORM — Inside Health Policy’s Brett Coughlin reports: “The current director of the CMS Office of Research, Development and Information (ORDI) – Timothy Love – is being transferred to the White House Office of Health Reform, according to an internal e-mail obtained by Inside Health Policy. Sources say the move may be an important step towards putting in place the new CMS Innovation Center called for by the health reform law. ‘Obviously, Berwick is gonna want his guy in there,’ said one source familiar with the e-mail, referring to President Barack Obama's choice to head CMS, Donald Berwick. ORDI is tasked with developing and implementing demonstration and pilot programs at CMS. The Innovation Center – created under the health reform law – is expected to largely replace ORDI.’(subscription required)

ELECTRONIC MEDICAL RECORDS IN QUESTION — The federal government has funded electronic medical records to the tune of over $1 billion under the Obama administration. A new report from Arizona State University will surely raise some eyebrows. ModernHealthcare.com’s Joseph Conn reports: “Researchers from the business school at Arizona State University, Tempe, say their work suggests electronic health-records systems in hospitals increase hospital costs, nurse staffing levels and the incidence of complications, but lower mortality rates for some conditions, according to a published report.”

Study author ASU assistant professor Raghu Santanam: “There’s a disconnect in the policy world that assumed that with all of the records moved into the computer system, nurses and other hospital personnel could spend less time running around looking for charts and that they would have more time to spend with patients. While some documentation time was reduced, a lot of time at computers may have been added, especially at organizations just learning to implement the new technology in a likely transition period. Higher levels of nurse staffing were really needed.”

STATES:

ABORTION BATTLE MOVES TO TENNESSEE, MISSISSIPPI — Chattanooga Free Press Times’ Emily Bregel reports: “A bill that critics say would constrain significantly access to medically needed abortions easily passed the Tennessee General Assembly last week, but legislators appear starkly divided in their assessments of what the bill actually does. The language of the bill, which is awaiting approval or veto from Gov. Phil Bredesen, prohibits the coverage of abortion in any health plan offered through the state insurance exchange that would be created in 2014 under the federal health care reform bill. The text of the bill makes no mention of any exception for the case of rape, incest or if the mother’s health is in danger. But a number of the bill’s supporters said they thought the bill was primarily intended to ensure that taxpayer dollars would not be used for abortion coverage in the state health insurance exchange. They also believed that it did not affect long-standing exceptions for extreme cases, such as rape.”

The Associated Press reports: “Mississippi lawmakers on Wednesday sent Gov. Haley Barbour a bill to ban public funding for most abortions, a move that critics said is unnecessary because it repeats what’s been in state law the past eight years.”

CONNECTICUT WARNS OF DOCTOR SHORTAGE AS REFORM ROADBLOCK — The Hartford Business Journal’s Greg Bordanaro reports: “When health care reform begins to take effect in Connecticut, it will undoubtedly mean insurance for tens of thousands of people who have lacked coverage. But that doesn’t mean they will be able to find a doctor to see them. The Connecticut State Medical Society is warning of a major shortage of primary care physicians in the state that, if not addressed soon, will lead to longer waiting periods for patients or a lack of access to doctors for the newly insured. According to a survey by the medical society, which polled 498 doctors, 28 percent of internists and 26 percent of family physicians said they already are not accepting new patients.”

VERMONTERS RALLY FOR SINGLE-PAYER BILL DESPITE GOVERNOR'S 'CONCERN' — The Times Argus’ Thatcher Moat reports: “The rally Saturday was … an effort to make sure the health care bill pending in the Legislature is the strongest it can be … That bill, S.88, sponsored by state Sen. Doug Racine, calls for hiring a consultant to design potential new health care models for Vermont, including a single-payer system. The House passed the bill April 23, making additions that expand the Blueprint for Health program and cap annual hospital budget increases. The Senate is expected to hold a final vote on the bill this week. It isn't clear whether Gov. Jim Douglas, a Republican, will sign the bill, veto it or let it become law without his signature. His spokesman has said Douglas likes parts of the bill but has ‘strong concerns’ about others.”

MIXED FINANCIAL PICTURE FOR MASSACHUSETTS INSURERS — The Boston Globe’s Robert Weisman and Kay Lazar report: “A long-awaited state report to be released today will probably add fuel to the debate about surging health costs by portraying a mixed financial picture of Massachusetts health insurers. The state’s eight health insurers finished 2008 with a total surplus of $2.5 billion, a more than four-fold increase from 1999 when the study period began, according to a 17-page executive summary of the report from the Division of Health Care Finance and Policy that was obtained by the Globe. However, when the report uses a more complete accounting measurement to examine the companies, one that also takes into account each firm’s liabilities and investments, the state’s largest insurer, Blue Cross and Blue Shield of Massachusetts, ended the period on a significantly less firm financial footing. That measurement, known as a risk-based capital ratio, shows Blue Cross’s health slipping by about a third.”

PULSE OP-ED:

LESSONS FROM MASSACHUSETTS — On the Boston Globe’s editorial page, Massachusetts Connector executive director Jon Kingsdale writes: “Four years after enactment, Massachusetts has learned about the challenges of implementing near-universal coverage. Here are a few lessons:

“1. It’s a campaign: In any successful campaign, continuous progress must be demonstrated and broadly communicated. In Massachusetts, we built partnerships with private and public groups, so that people heard and read about the law everywhere — at Fenway Park, in church, while shopping, or riding the subway. We launched this effort with the Red Sox, and held more than 300 educational forums across the state, the equivalent on a national scale of 15,000 outreach meetings. As a result, voter support for reform has remained high, ranging from 59 percent to 75 percent.

“2. Adequate resources: The Massachusetts Legislature appropriately funded implementation with $35 million in the first year; the equivalent on a national scale would be $1.65 billion. Never were shortages of time, expertise, or resources allowed to stand in the way of meeting legislated deadlines.”

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Reader Comments (15)

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"For example, Reps. Tom Perriello, D-Va., and Betsy Markey, D-Colo., have sent mass mailings touting how the law closes the Medicare ‘doughnut hole.’”
Yeah. And maybe she can also tell seniors what to do when medicare starts cutting back on cancer screenings and other forms of testing to come up with their half trillion dollar cut to medicare services.

Fannie Mae, Amtrack, the post office. I could go on and on. How many things has the federal government run at loss even when they originally said it wouldn't cost the taxpayers? States are rejecting these high risk pools because they know it isn't affordable. At some point we have to say "we can't afford everything a liberal heart desires" or we are going to wake up one day and be Greece.

Dan - "And maybe she can also tell seniors what to do when medicare starts cutting back on cancer screenings and other forms of testing to come up with their half trillion dollar cut to medicare services."

Please. You're making things up out of whole cloth. There are no plans anywhere to cut efficacious cancer screenings from coverage.

Take the Post Office. The only reason the PO current runs a deficit is that they cannot control their own rates. They have survived for a VERY long time on the basis of what they charge for services, not taxes.

Your implication is somehow that because the government operates it, it is poorly run. The Post Office's problem is not that it is poorly run. One big problem is people shifting to E-mail. This is a change in the environment of the PO, not a management problem. So they have to adapt.

As far as the high risk pools, many existed before PPACA was passed. They were a central tenet of McCain's reform plan.

Is there any solution that appeals to you conservatives? Apparently not even your own...

Really, running a high risk insurance pool is perfectly suited to the public sector. It's actuarial work and administrative overhead. No real need for extensive marketing or innovation. State governments have been doing the work just fine.

Frankly, red states opposing this are just playing politics. It is nothing to do with the utility or expense of the high risk pools.

jhoger says..."Your implication is somehow that because the government operates it, it is poorly run. The Post Office's problem is not that it is poorly run. One big problem is people shifting to E-mail. This is a change in the environment of the PO, not a management problem. So they have to adapt."...You cannot be serious? Who drives this evolution? Who drives the adaptation? Is it suppose to happen on it's own? Stick with programming man. How do some businesses evolve and others cannot? Maybe a business strategy? Who implements that? Innovation in changing times doesn't just magically happen. And if you own a company that is $5b in the hole and just keep shoveling money in without changing the plan or complete model you are a POOR steward, manager, owner, whatever. Good managers/owners adjust with the times. Bad ones continue the same failed practices hoping for a different outcome (I think someone called that the definition of insanity). The Government's old tired Answer...Raise the rate! And they wonder why FedEx and UPS are eating their lunch. Seriously...Maybe the problem IS the changing times but if the government can't adjust then it IS poor management.

"Please. You're making things up out of whole cloth. There are no plans anywhere to cut efficacious cancer screenings from coverage." jhoger, do you remember the plans to push back the eligibility age for cervical cancer exams less than 6 months ago? Where do you think they are going to come up with a half trillion dollars? The tooth fairy?

jhoger, it is exactly my assertion that most things the government runs are run poorly. The one exception is the military. And even they have had their fair share of $500 toilet seats and $1,000 wrenches. Things that would never be allowed to happen long term in the private sector because of a little thing we like to call a profit motive. Look it up. You might like it if you ever learned about it.

Lib lies, you are exactly correct! An inability to adapt to a material change in your environment that moves you from profitable to losing money is bad management no matter what jhoger read in his MBA classes. Change is an opportunity or a death sentence and which way it goes is generally determined by the leadership of the organization.

I see Dan is back at his fairy tales and urban legends......UPS and FedEx eating the Post Office's lunch..the reason UPS and FedEx can manage their profit is because they will charge for delivery to rural areas and then pay the Post Office far less to deliver it because the Post Office has rates set for it......Elimination of Cancer Screenings......Dan..you are simply ignorant and a fool. You never have facts unless they are distorted. You have no credibility. Everyone reading this...let's all ask Dan for a link that explains a reduction in benefits. Let's see if he can come up with one.

Dan - "An inability to adapt to a material change in your environment that moves you from profitable to losing money is bad management no matter what jhoger read in his MBA classes."

First of all, NO. A manager for the most part does not control the environment. It is external to the firm. Most businesses will experience periods of l. If the future outlook of the company is good though, and rebuilding market share or getting the production line going again would be made more expensive by shutting down operations, managers may rationally decide to continue operations.

Another thing: most work is run by a bureaucracy. There is no significant difference between a corporate bureaucracy and a government bureaucracy... well, other than the fact that government spends a lot of time investigating itself to make sure it isn't wasting any money.

Organizations, and the rules they operate by are created to satisfy a want/need, fulfill requirements. The Post Office environment has changed, and they have presented plans to adapt that will allow them to remain solvent, including raising rates and ending Saturday service, among other things.

During implementation they will run a deficit. But most private businesses also operate unprofitably for periods of time at one point or another.

Government is different from the private sector: it can be made to fulfill requirements where the time horizon is too long for a private business, or where profitability cannot be proven to be likely. For example, when NASA put men on the moon. The real question is whether what is being done is worth it.

Dan - "An inability to adapt to a material change in your environment that moves you from profitable to losing money is bad management no matter what jhoger read in his MBA classes."

First of all, NO. A manager for the most part does not control the environment. It is external to the firm. Most businesses will experience periods of l. If the future outlook of the company is good though, and rebuilding market share or getting the production line going again would be made more expensive by shutting down operations, managers may rationally decide to continue operations.

Another thing: most work is run by a bureaucracy. There is no significant difference between a corporate bureaucracy and a government bureaucracy... well, other than the fact that government spends a lot of time investigating itself to make sure it isn't wasting any money.

Organizations, and the rules they operate by are created to satisfy a want/need, fulfill requirements. The Post Office environment has changed, and they have presented plans to adapt that will allow them to remain solvent, including raising rates and ending Saturday service, among other things.

During implementation they will run a deficit. But most private businesses also operate unprofitably for periods of time at one point or another.

Government is different from the private sector: it can be made to fulfill requirements where the time horizon is too long for a private business, or where profitability cannot be proven to be likely. For example, when NASA put men on the moon. The real question is whether what is being done is worth it.

johger, where to begin. First I never said a manager had control over the external environment. There you are arguing against something that was never said. I said a manager deals with change and adapts the company to better suit change. Think of Darwin's principal of survival of the fittest. To compete in a new environment, a company has to adapt. Just like a biological organism. Get it? Second, there is a big difference between a corporate beaurocracy and a government one. It's called a profit motive. A corpororation that consistently loses money is put out of business by it's failure. A government that fails in the same way just pulls more taxes from it's citizens or borrows more money like Greece....and us. Third, a corporation may lose money for a brief period of time in the beginning. But mature companies do not lose money like Fannie and Amtrack and the Post Office and stay afloat. And finally, there is no way the leaders of any business can lose money in a changing environment and be labeled as competent or worthy of keeping their jobs. This isn't a public school where everyone is special in their own special way and there are no winners or losers. This is real life where performance matters and the consequences are real. I'm surprised they didn't teach you that in graduate school. Seems kind of odd to me. Maybe you should ask for your money back?